Provider Demographics
NPI:1952001364
Name:PAPOULIAS, SHANNON (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:PAPOULIAS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3968 OAK ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3728
Mailing Address - Country:US
Mailing Address - Phone:703-966-3748
Mailing Address - Fax:
Practice Address - Street 1:3968 OAK ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3728
Practice Address - Country:US
Practice Address - Phone:703-966-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1005180163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant